Abstract Background: The prevalence of hyperuricemia in CKD pediatric patients increases in parallel with the estimated glomerular filtration rate (eGFR) decline, which is present in 40% to 60% of patients with CKD stages 1 to 3 and in 70% of patients with CKD stage 4, in this study, we aimed to study the prevalence of hyperuricemia among CKD paediatric patients in stages 2,3,4 and its effect on cardiac indices, and effect of allopurinol treatment on cardiac indices. Aim of Study: The Prevalence of hyperuricemia among CKD paediatric patients and its effect on cardiac indices. The impact of treatment with allopurinol for 6 months in hyperu-ricemic CKD pediatric patients on cardiac indices. Patients and Methods: A prospective cohort study was conducted on 78 CKD pediatric patients in stages 2,3,4, recruited from nephrology clinic Ain Shams University Hos-pital during the period from December 2019 to February 2020. Results: There were highly statistically significant negative correlation between serum uric acid level and GFR with p-value >0.001 and there were a highly significant relation between the level of uric acid and CKD stage with p-value >0.001, and there were a highly significant diffirane in cardiac indices before and after the treatment. There was a highly significant relationship between the level of uric acid before and after allopurinol treatment which showing the effectiveness of the drug for decreasing the uric acid level in the blood and it's effect on the kidney and cardiovascular systeme. Conclusion: 6 months administration of allopurinol treat-ment in hyperuriamic CKD pediatric patients in stages 2,3,4 resulted in improving the laboratory data of (uric acid level, serum creatinine, GFR) and showing a significant effect on cardiac indices (LV structure, systolic and diastolic function).